Medicines accessibility in a national health service

Abstract

Access to medicines is a critical factor in maintaining public health. Inadequate accessibility is often a result of gaps within the public health system. Addressing these deficiencies can improve health outcomes and enhance patient satisfaction. This study aims to address the gaps in the Maltese public healthcare system by introducing a reimbursement policy. A literature review was conducted to compare the Maltese healthcare system with international models. Insights informed the design of two focus group discussion guides: one to investigate views on which reimbursement policy and methodology would be suitable for Malta, taking into consideration personalised and innovative medicine (Focus Group A) and another to examine barriers to accessibility and ethical aspects (Focus Group B). Both guides were validated by five pharmacists, with face validity assessed by a linguistic expert. Focus Group A included experts from six pharmaceutical stakeholder entities, and Focus Group B consisted of participants from six patient representative groups. The data collected underwent PESTLE and SWOT analyses. Analysis results were used to design a reimbursement policy, subsequently validated through Focus Group C, consisting of five experts from pharmaceutical stakeholder entities. Results suggest the reimbursement policy could reduce wastage, improve patient satisfaction, and improve sustainability compared to the government formulary system. While beneficial, respondents in Focus Group A (N=10) indicated that patients might resist the transaction to a reimbursement system (n=8). Focus Group B (N=6) emphasised preventing medicine shortages due to the significant negative impact. In conclusion, implementing a reimbursement model in a small market such as Malta faces multiple barriers, both politically and from patients, especially when transitioning from a government formulary system. Pilot studies are recommended to assess patient response and the impact of the reimbursement model on accessibility.